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Recurrence is by definition the development of one or more of the original deformities (equinus, varus, adductus and cavus) after the full correction of the clubfoot is obtained. The cause of recurrence is unknown, but it is the same mechanism that initially caused the deformities to develop and is related to the rapid growth of the foot. Recurrence is rare after the age of 4- 5 years and almost never occurs after 7 years of age. Recurrence is often effectively and easily treatable when discovered at an early stage. Adduction of the forefoot is the most common residual deformity in clubfoot associated with supination of the foot [Tarraf and Carroll]. Undercorrection at the time of initial surgery, medial displacement of the anterior part of calcaneum and navicular bones around the talus were considered to be some of the causative factors. AIMS AND OBJECTIVES: 1. To analyse the effectiveness of the combined cuboid /cuneiform osteotomy for correction of residual forefoot adduction deformity in idiopathic clubfoot. 2. To study the improvement in forefoot flexibility, gait and overall functional outcome. 3. To study the advantage of this procedure over other techniques of osteotomy. MATERIALS AND METHODS: 16 cases (feet) in 11 children, who presented to our institution between November 2010 and November 2012 with residual forefoot adduction deformity. The parents complaints included in toeing gait and difficulty in wearing normal footwear in their children. All had undergone a full posteromedial soft tissue release using the Turco‟s incision with lengthening of tendoachilles for idiopathic clubfoot, and followed up for a period 2 years. Ethical committee approval was obtained for the procedure. Inclusion Criteria: 1. Rigid forefoot adduction deformities with associated cavus, equino varus deformities, 2. Age group between 3 – 10 years, 3. Children with idiopathic clubfoot who have failed to respond to conservative treatment and soft tissue procedures. Exclusion Criteria: 1. Clubfoot secondary to arthrogryposis multiplexa, amniotic band syndrome, spasticity, 2. Children 11 years of age, 3. Relapsed clubfeet for several times. The mean age at the time of surgery was 6.5 years (range 3- 10 years). There were 7 boys (10 feet), 4 girls(6 feet). The right foot in 9 children and left foot in 7. RESULTS: Results according to point scoring system : (modified Bensahel et al ) approved by the International clubfoot study group . Of the 16 feet treated, 8 feet (50%) had excellent results, 5 feet (32%) good, 2 feet (12%) fair and 1 foot (6%) poor results. Result s according to point scoring system used : (modified Bensahel et al) approved by the International clubfoot study group. Of the 16 feet treated, 8 feet (50%) had excellent results, 5 feet (32%) good, 2 feet (12%) fair and 1 foot (6%) poor results. CONCLUSION: 1. The most common deformity seen after surgical correction of idiopathic clubfoot is forefoot adduction. 2. The etiology is unknown , but the most probable cause being undercorrection at time of primary surgery and irregularity in wearing brace postoperatively. 3. The combined osteotomy is a safe procedure and allows satisfactory correction of the residual forefoot adduction deformity and achieving a straight plantigrade foot. 4. No modified foot wear or shoes were required to be worn for a long term after the correction was achieved unlike other procedures. 5. The operation is not suitable for non-idiopathic clubfoot, secondary clubfoot, and in those feet with repeated relapse and unsuitable skin condition. 6. The long term morbidity must be evaluated by regular follow up to assess the functional outcome.

A study on outcome of combined cuboid/cuneiform osteotomy for correction of residual forefoot adduction deformity in idiopathic clubfoot